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Before they were born, an Orlando couple's children spent 12 years suspended in time.
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By Jeff Kunerth
Orlando Sentinel Staff Writer
April 8, 2004
The Mangsen triplets are 9 months old now, colliding into one another with their rolling walkers like baby bumper cars.
There's angelic Angelina, the good baby who never cries, never fusses. Matthew, who out-eats, out-weighs, out-whines his siblings. And Justin, the perpetual-motion machine nicknamed "The Rocket" by his parents.
But these are no ordinary triplets. They were born from embryos that their doctor said had been frozen for nearly 12 years.
"We never thought embryos of this age would be as viable and potent. To have all of them survive after implantation is quite remarkable," said Mark Trolice, the Winter Park fertility doctor who provided the three donated embryos to Chris and Sylvia Mangsen.
Births from embryos open the door to parenthood for infertile couples such as Chris and Sylvia, but also pulls back the curtain on the 400,000 embryos in the United States suspended in time and liquid nitrogen.
Since the first baby was born in the United States from a frozen embryo in 1986, embryos have been the center of controversy over stem-cell research, been caught in the middle of custody battles and ignited debate over the beginning of life.
But it is indecision and abandonment that has made the long-term storage of frozen embryos a medical problem for fertility centers. Couples with unused frozen embryos often procrastinate for years about whether to keep them in storage, allow them to thaw and expire, donate them to medical science or pass them on to other couples. Only about 2 percent of the nation's frozen embryos go to infertile couples.
"People don't want to let go of the embryos. It's an emotional attachment -- it's the potential for a baby," said Kate Howell, director of Xytex Tissue Services, a long-term embryo-storage facility in Augusta, Ga.
The unused, frozen embryos result from the in-vitro-fertilization process by which 10 or more eggs are removed from a woman and combined with a man's sperm. From the resulting embryos, as many as four are transplanted into the womb. The remaining embryos are then "cryopreserved" in canisters of liquid nitrogen about 320 degrees Fahrenheit below zero.
A study by the Society for Assisted Reproductive Technology in 2003 found that 88 percent of those 400,000 frozen embryos were being held for future use by the couples who produced them. Some couples are waiting to see whether their initial attempts at pregnancy succeed. Others will use the extra embryos to produce siblings. And some embryos remain frozen in the event that a couple loses a child to disease or accident.
At the Jones Institute for Reproductive Medicine in Norfolk, Va., some frozen embryos go back 15 years, director Jacob Mayer said. For some clients, the thought of destroying the embryos or giving them to research is akin to killing their offspring. And donating them to other couples is like giving their children away.
"Sometimes, it's a hard decision to make. People tend to want to put that off, push it to the back of their minds," Mayer said.
One 37-year-old mother of triplets born in 2002 said she and her husband still are struggling with the decision of what to do with their extra frozen embryos.
When she thinks about giving up the embryos to another family, she imagines her boys having siblings raised by someone else.
"One thought that goes through your mind is, 'Oh, they are going to have some little brother or sister somewhere else.' Basically, you are giving them up for adoption," she said.
Couples pay a storage fee, often about $25 a month, to the fertility centers that must periodically ask clients what they want done with the embryos, which are stored in what fertility clinics call "dewars."
"It becomes a storage issue. If you run out of room in the dewars or you need another dewar and another dewar, where are you going to put them?" said Melissa Dirkes, office manager for the Center for Reproductive Medicine in Orlando.
Joining those embryos whose destiny is not yet decided are others that have been forgotten or abandoned.
A study found that of the 400,000 frozen embryos, about 9,000 were set for destruction, 11,000 given to research, 9,000 donated to families like the Mangsens and 14,000 whose status was uncertain -- including abandonment.
Although there is no law regarding what fertility centers can do with abandoned embryos, the American Society for Reproductive Medicine guidelines say that after five years clinics can dispose of unclaimed embryos but cannot donate them to other couples or for medical research.
This creates problems for fertility doctors such as Craig R. Sweet in Fort Myers, who has about 70 frozen embryos from couples he can no longer find. To donate the embryos to other couples, Sweet said, he would have to file individual lawsuits against former clients to establish "property rights" over the embryos.
"It is unfair to the embryos abandoned by their parents and then abandoned by their caregivers -- us," Sweet said. "It becomes a property issue that has to go through the courts to insulate the clinics from lawsuits."
The Mangsens had been trying to have children ever since they married six years ago. The couple were unable to conceive because Sylvia is in her 40s and Chris is sterile from radiation treatments for cancer when he was in his 20s. Sylvia Mangsen was 42 when she underwent her first attempt at in-vitro fertilization with donated frozen embryos.
When that try failed, their doctor offered them the 12-year-old embryos, which came from a couple who relinquished their rights to the embryos so another couple could use them.
The Mangsens were hesitant to use embryos twice as old as their marriage.
"My husband and I had to think twice because they were 12 years old. I asked Dr. Trolice what are the chances of them being normal as opposed to a fresh group of embryos. He said there is no difference. We just decided to go for it," Sylvia said.
Although the embryos were free, the procedure was not. All but about $2,000 of the cost was paid for by the Mangsens' health insurance.
The fact that all three embryos produced babies astounded the parents and the doctor.
"We were in uncharted waters. No one could predict the viability of these frozen embryos," Trolice said.
It was a novelty when the triplets were born July 3, 2003, but since then an Israeli woman produced twins from her own 12-year-old frozen embryos.
Born less than 5 pounds each, the Mangsen triplets have had some health problems related to their low birth weight. But at nine months, they appear to be healthy, normal babies.
The Mangsens, who live with Sylvia's parents in their Orlando home, have experienced financial problems since the births of their babies. Because of a heart condition caused by the cancer treatments, Chris Mangsen, 44, has been unable to work and has filed for Social Security disability. His wife stays home to care for the children. Two days before their triplets turned nine months, the couple filed for bankruptcy.
Money's tight, but for Chris and Sylvia the entertainment is free -- watching their babies grow.
"They're all beautiful kids, happy, healthy," Chris Mangsen said. "It's like a puddle of giggles."
Jeff Kunerth can be reached at jkunerth@orlandosentinel.com or 407-420-5392.
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